A Clinicopathologic Review of Esophageal Candidiasis
Sonja Chen, Ralph Sams, Nick Shillingford, Evgeny Yakirevich, Albert Ross, Leila Noble, Rose Tavares, Murray Resnick, Shamlal Mangray. Rhode Island Hospital and Alpert Medical SChool of Brown University, Providence, RI
Background: Esophageal candidiasis (EsoCan) is one of the most commonly encountered esophageal infections in gastrointestinal pathology and is typically seen in immunosuppressed or predisposed patients because of administered medication. However, we have seen cases without any apparent predisposition. As far as we are aware, there has been no recent systematic study of EsoCan so we sought to establish characteristics of these patients.
Design: We reviewed the clinical, endoscopic and histopathologic features of EsoCan retrieved from our surgical pathology files for a ten year period. Cases were defined by clinicopathologic criteria in which classical endoscopic findings of white plaques, patches or furrows were correlated with the histologic demonstration of fungal pseudohyphae consistent with Candida spp. involving intact mucosa with an inflammatory response, or supported by positive esophageal brushing. Adult and pediatric (< 18 years; Pedi) cases were compared. All sections used in making the diagnosis including hematoxylin and eosin (H&E) sections or available Grocott methenamine silver (GMS) and periodic acid-Schiff with diastase (PAS-D) stains were reviewed.
Results: Of the cases retrieved, 13% (14/107) were Pedi (median: 14, range: 7-17 years; 13 females, 1 male) and 87% were adults (median: 64, range: 27-94 years; 60 females, 33 males). Six of 14 (43%) Pedi cases had no predisposing factors, of which 83% (5/6) were females. In the remaining 57%, underlying predisposition included immunosuppressive therapy, autoimmune disease (AuID), distorted anatomy and antibiotic use.
In 68 % (63/93) of adults there were no predisposing factors, of which 70% (44/63) were females. In the remaining 30%, underlying predisposition included (AuID), malignancy, AIDS, diabetes mellitus, COPD/asthma, ESRD, antibiotic use, SCD, foreign body, alcohol use and achalasia.
PAS-D was positive in 83% (89/107) of cases while GMS was positive in 68% (73/107) of cases. The staining pattern was similar in cases that were positive with both stains. Assessment of PAS-D was easier as removal of glycogen facilitated identification of pseudohyphae whereas on GMS background granular staining of squamous epithelium made interpretation more challenging.
Conclusions: In Pedi and adult cases >40% and >65% had no evident predisposition and females predominated (>70%). Although subtle immune abnormalities cannot be excluded, these findings raise the possibilty of hormonal influence. Overall we found PAS-D to be easier to interpret and cheaper than GMS, and therefore more cost-effective.
Monday, March 19, 2012 1:00 PM
Poster Session II # 88, Monday Afternoon